Forms / Applications

City Homes Insurance Program

In general, a building that fits our CHIP program is one that is $5 Mil in values or less, 6 stories or less, 30 units or less, is of JMS construction or better, (Frame construction is acceptable in San Francisco, CA and Seattle, WA) and is located in one of the approved territories. Click here for a mirror image of our application, which further details what will be a fit for this program.

If answers are not available in the drop down options below, this means that the building is not eligible for our City Homes Program, but may still be eligible for our other programs. You can access those other programs by calling your regular underwriter, faxing in an Acord application to 212-297-3130 (you will receive a call within 24 hours), calling Jim Tesoriero at 212-297-3150, or calling our main line at 212-297-3100 and asking to be transferred to the appropriate person.

This online quote process is for one-location risks only. Multiple location risks require a longer version of this application - please contact us via one of the above 4 mentioned ways for an indication before completing any additional applications. This online quote process is available only to agents/brokers with DP executed brokerage agreements in place. Click here to access our brokerage agreement.

City Homes Insurance Program Application:

Agency/Brokerage Name:

Agency/Brokerage Address1:

Agency/Brokerage Address2:

Agency/Brokerage City:

Agency/Brokerage State:

Agency/Brokerage Zip:

Contact Name:

Phone Number:

Fax Number:

Email Address:

Email Address Confirmation:

1. Name Insured:

Mailing Address Line 1:

Mailing Address Line 2:

Mailing City:

Mailing State:

Mailing Zip:

2. Building Address:

Building City:

If Chicago Metro, Enter City:

Building State:

Building Zip:

Effective Date

3. Loss History:

Have there been any GL or Property claims in the last four years? Yes No

If no, we will provide a quote, subject to receipt of hard copy carrier loss runs, prior to binding. If yes, please list any claims for the past 4 years.

Date of Loss: Incurred Amount: Status: Details:

4. Occupancy Type:

# of Habitational Units:

# of Stories:

# of Buildings:

For Rental buildings, is the building owner occupied? Yes
No   N/A

Does the building allow short-term or seasonal rental of units? Yes No

If yes, what percentage?

5. Building Information:

Year Built:

Year Purchased:

Building Value:

Business Income:

Contents:

TIV: (Max. $5,000,000)

Construction:

Percentage Occupied: %

Elevators:

Total Bldg Sq Feet:

Renovation Updates:

Year of Renovation:

Gut Rehab:

Roof:

HVAC:

Plumbing: